Management of ingested foreign bodies. How justifiable is a waiting policy?

Non-interventional outcomes of adult foreign body ingestions

INTRODUCTION

Foreign body ingestions are a common problem in the emergency department. Patients often undergo invasive interventions that require significant resources. Current recommendations based on limited studies, are to attempt endoscopic removal of objects that are sharp or greater than 2.5 cm at or above the proximal duodenum. We hypothesized that many small and sharp objects will pass spontaneously without complication.

METHODS

We performed a retrospective study of all foreign bodies ingested by adults that were not removed initially by endoscopy over five years. We recorded foreign body size, shape and location, radiographic results, interventions performed, and demographic data. Regression analysis was used to determine any significant associations with the outcome of late intervention.

RESULTS

117 patients with 171 encounters met inclusion criteria with an average age of 33 years. 74 % of patients had a known psychiatric history. The most common foreign body was a razorblade. Fifteen patients had late intervention with twelve endoscopies and three exploratory laparotomies. 87 % of these late interventions were for failure to progress determined by the treatment team. There were no small bowel obstructions. One patient had a recto-sigmoid perforation from a pencil. Analysis indicates that size and sharpness were not significant risk factors for later intervention.

CONCLUSION

Our study indicates that small objects, even sharp foreign bodies including razorblades, can pass spontaneously without intervention. If larger, future studies show the same conclusion, there should be a reconsideration of current guidelines.

An unusual etiology of acute intestinal occlusion: The swallowed missing dentures a case reports and literature review

INTRODUCTION

Denture swallowing is an uncommon incident. However, it should be suspected in edentulous elderly patients who wear removable dentures which are poorly cared for and maintain. The existence of neuro-psychiatric disorders may contribute to the occurrence of this adverse event.

CASE PRESENTATION

We report the case of an 85-years-old woman admitted to emergency with acute intestinal occlusion. The investigations concluded that the bowel was obstructed by a foreign body blocked in the terminal ileum. There was a high suspicion that his dental prosthesis had been swallowed. Removal of the dental prosthesis was achieved surgically after laparotomy.

DISCUSSION

Foreign bodies in the esophagus could be responsible of a variety of symptoms, including dysphagia, airway obstruction and even perforation. In the gastrointestinal tract foreign bodies may be responsible of fewer specific symptoms, including abdominal pain, melena or perforation. The blockage will occur in anatomical strictures. At the most appropriate situations, removal should be performed through endoscopy, although in case of failure of procedure or complication, surgery will be unavoidable.

CONCLUSION

Ingestion of a dental or other foreign object is a clinical condition that is more common in pediatric populations, but is very rare in healthy individuals. Denture swallowing is insidious in itself and may lead to a complicated course, if not properly managed. Although most of these can be conservative, careful monitoring is necessary to avoid such adverse event.

Accidental ingestion of a dental object during a periodontal surgical procedure on an IV sedated patient: Case management

INTRODUCTION

Foreign-body aspiration (FBA) and ingestion (FBI) are rare but serious events that occur in dental offices throughout the world every year. Such events can have significant medical, legal, and financial consequences for both the dental clinician and the patient. By presenting this case study, we aim to highlight the proper management and possible sequelae of such an event.

METHODS AND RESULTS

A 72-year-old woman underwent a dental procedure with intravenous sedation. In the process of dental treatment, a dental bur was accidentally ingested. The patient was promptly referred to an urgent care clinic, where serial abdominal radiographs were taken over several days to track the course of the bur through the digestive system. The bur was successfully removed without complication.

CONCLUSION

Prompt management and referral of dental FBA and FBI cases, followed by successful object retrieval, lead to uncomplicated resolution of the event.

KEY POINTS

Why is this case new information? This case presents the proper management of the FBA and FBI, particularly for IV sedated patients who require immediate action to mitigate and prevent serious complications. What are the keys to the successful management of this case and how can the risk of FBA and FBI be mitigated? The use of throat packs or rubber dams helps prevent foreign body aspiration and ingestion. Attaching floss to appliances and objects when appliances are used intraorally. (Specifically, to implant guide pins and implant screwdrivers.) Thorough isolation of the oropharynx from the mouth using a barrier, such as a gauze pad or rubber dam, during bracket placement, orthodontic appliance adjustment, and screwing or cementing of implant crowns Short and extra short implants should be connected by ligature to the implant handpiece. What are the primary limitations to success in this case? Lack of a throat pack Failure to confirm connection of bur to handpiece Patient's anatomy (redundant colon) preventing natural expulsion of the bur.

Effects of Accidental Swallowing of Orthodontic Appliance on Gastrointestinal Tract and Airway: An Evidence-Based Review of Case Reports

Background:

Contemporarily, the use of innovative orthodontic appliances or their components has increased for safer, quicker results, and more comfort of the patient. But, researchers rarely highlight the potential demerits of accidental ingestion of these appliances. Thus, the present study aimed to investigate the evidence-based literature on the accidental swallowing of these appliances and their effect on the gastrointestinal tract (GIT) and airway.

Method:

An electronic search was performed on PubMed, Medline, Scopus, The Cochrane Library, and EMBASE until April 11, 2021. Methodological quality and synthesis of case series and case report tool (MQCC) was applied to determine the quality of these case reports and series. The outcome variable was to assess its effect on airway and GIT, and methods of removal of these foreign bodies. Meta-analysis was not performed as the study included case reports and case series in which no control groups were present.

Results:

Out of 113 case reports and series, 29 articles were included in this systematic review. Only 31% of articles have satisfied the MQCC scale and maintained as high-quality case reports, 43% of articles were medium to high quality, and 26% designated as low quality.

Conclusions:

Eighty percent of the accidental ingested orthodontic appliances that pass uneventfully through the gastrointestinal system require a fiber-rich diet and laxatives. A total of 10% to 20% lacerates oral, pharyngeal, and gastrointestinal mucosa result in pain, bleeding requires laryngoscope, endoscopically and laparoscopy with use of Magill’s forceps. Only 1% of cases have presented with a high morbidity and mortality alarming for surgical removal of ingested component. Thus, the precautions to be taken to overcome such incidences are tying silk thread to activation key, use of recent bonding method, use of contrast colors of removable appliances as the color merges with mucosal color, and operator position should be 7 O′ clock.

Successful colonoscopic removal of a foreign body that caused sigmoid colon perforation: a case report

Large bowel perforation is an acute abdominal emergency requiring rapid diagnosis for proper treatment. The high mortality rate associated with large bowel perforation underlines the importance of an accurate and timely diagnosis. Computed tomography is useful for diagnosis of ingested foreign bodies, and endoscopic repair using clips can be an effective treatment of colon perforations. We herein describe a 78-year-old man with sigmoid colon perforation caused by accidental swallowing of a jujube pit. The jujube pit had become stuck in the wall of the sigmoid colon and was successfully removed by colonoscopy, avoiding an aggressive surgery. As a result of developments in endoscopic techniques, endoscopic closure has become a feasible option for the management of intestinal perforation.

Accidental intraoperative ingestion of a paralleling pin during implant placement

Foreign body ingestion although unusual may be possible during dental treatment when placing any implants, prosthetic crowns, restoration, endodontic treatment, or orthodontic treatment. When the ingestion occurs, it is always crucial to locate the foreign body within the patient's body by taking bi-planar radiographs. Any features of airway distress or obstruction should be ruled out and if it is located in the gastrointestinal (GI) tract, the nature and size of the material will decide the protocol of retrieval of the ingested object. However, there is always a risk of intestinal perforations or obstructions secondary to the ingestion. Here is a case report wherein there was an accidental ingestion of the paralleling pin during the first stage of the implant placement with indications of various GI investigations and recommendations to avoid instrument ingestion.

Ingested Foreign Bodies: Do We Need a Specific Approach When Treating Inmates?

The management of foreign bodies in the gastrointestinal tract is not standardized. Foreign body ingestions in prisoners are always intentional and inmates can be manipulative, which makes medical decision even more difficult. Our objective is to propose a decisional algorithm for management of foreign body ingestion in prisoners. We reviewed the records of 198 admissions for foreign body ingestion for a 10-year period. Type and number of ingested foreign bodies, radiographic findings, outcome as well as the management method including conservative, endoscopic removal, or surgical treatment were analyzed. Most cases were managed conservatively (87.6%). Endoscopy of the upper gastrointestinal tract was performed in 37 cases with a success rate of 46 per cent. In 9.3 per cent of cases, the final treatment was endoscopic. Only five patients required surgical treatment, being emergent just in one case. We advocate conservative treatment for asymptomatic patients with foreign body ingestion. Endoscopic removal is proposed for pointed objects or objects bigger than 2.5 cm located in the stomach. Objects longer than 6 to 8 cm located in the stomach should be removed by endoscopy or laparoscopy. Patients with objects in the small bowel or colon should be treated conservatively unless there are complications or they fail to progress.

Sharp Object in the Belly: A Case of Pediatric Intentional Razor Blade Ingestion in the Emergency Department

Ingested foreign object (FOB) is a common complaint in the emergency department (ED), especially in pediatric patients. While many FOB ingestions are benign, sharp objects, including razor blades, are of particular concern given the acute risk of perforation throughout the gastrointestinal tracts. The majority of razor blade ingestions involve prisoners and psychiatric patients, which can complicate the diagnosis and treatment. Although literature suggests that risks of perforation and complication may be high, limited research available on sharp FOB ingestions supports a general non-interventional strategy. Instead, close follow-up and serial radiographs for natural passage are recommended for the majority of cases. We highlight the case of a 17-year-old female who presented to the ED for suspected FOB ingestion and was found to have a singular 3.0 x 0.5 cm razor blade on abdominal radiograph following an unremarkable initial evaluation. In line with prior literature, surgical consult supported natural passage with serial radiographs, and the patient was subsequently discharged home with a recommended bulk food diet. 

The mystery of the ureteric stent in the lumen of the terminal ileum

A 65-year-old comorbid female patient presented to our urology department with a history of multiple interventions to treat severe overactive bladder symptoms. She had a history of clam ileocystoplasty, which was then converted to an ileal conduit due to failure to resolve her symptoms. She subsequently developed multiple complications, most significantly ureteroileal stenosis, managed with bilateral ureteric stents. She later decided on bilateral nephrostomies and subsequent antegrade stent insertion. At follow-up, the proximal end of the left stent remained within the kidney and the distal end was free within the abdominal cavity. There was further migration of the stent in its entirety into the lumen of the terminal ileum on subsequent imaging. She denied any significant gastrointestinal symptoms, signs or peritonitis. Consideration was made for the endoscopic removal of the stent by the gastrointestinal team; however, the patient refused any further procedures preferring to be monitored.

Complication of dislodged gastrostomy Foley catheter: antegrade migration into small bowel

A 65-year-old man with dysphagia underwent placement of a percutaneous endoscopic gastrostomy tube. He was cared for at a nursing facility where the tube became dislodged and was replaced with similar size Foley catheter. Patient was brought to the hospital with dislodged feeding Foley but none was found at the bedside. Diagnostic workup revealed antegrade migration of the catheter into the small bowel. Push enteroscopy was unsuccessful in retrieving the catheter because it was too far distal. Patient was observed for a total of 7 days. Due to lack of progress with conservative measures, a colonoscopy was performed to extract the catheter, thus avoiding the need for more invasive surgical measures. If a Foley catheter is used as a gastrostomy tube, it should be replaced with a dedicated feeding tube as quickly as possible and should always be affixed to the skin to prevent antegrade migration and associated complications.

Rectal perforation by inadvertent ingestion of a blister pack: A case report and review of literature

The accidental ingestion of a foreign body (FB) is a relatively common condition. In the present study, we report a peculiar case of rectal perforation, the first to our knowledge, caused by the inadvertent ingestion of a blister pill pack. The aim of this report is to illustrate the difficulties of the case from a diagnostic and therapeutic viewpoint as well as its unusual presentation. A 75-year-old woman, mentally impaired, arrived at our emergency department in critical condition. The computed tomography scan revealed a substantial abdominopelvic peritoneal effusion and free perigastric air. The patient was therefore submitted to an urgent exploratory laparotomy; a 2-cm long, full-thickness lesion was identified in the anterior distal part of the intraperitoneal rectum. Hence, we performed a Hartmann's procedure. Because of her critical condition, the patient was eventually transferred to the Intensive Care Unit, where she died after 10 d, showing no surgical complication. The ingestion of FBs is usually treated with observation or endoscopic removal. Less than 1% of FBs are likely to cause an intestinal perforation. The intestinal perforation resulting from the unintentional ingestion of an FB is often a difficult challenge when it comes to treatment, due to its late diagnosis and the patients' deteriorated clinical condition.

Trans-colonic foreign body penetration of the retro-hepatic vena cava. Report of a case and review of the literature

Foreign body ingestion is common in mentally impaired adults. Fortunately, the vast majority of all swallowed objects pass through the gastrointestinal tract uneventfully. For patients in whom conservative treatment fails, early endoscopic intervention is required. Surgery is seldom indicated and reports of perforation or penetration of the GI tract are anecdotal. We present a case of a 32 years old mentally impaired patient with a trans-colonic penetration of a foreign body into the retro-hepatic vena cava.

Ingestion of nine metallic nails with corrosive: what happened next?

A 20-year-old woman was brought to the surgery emergency department with the complaint of epigastric pain since 1 day following ingestion of multiple metallic nails with a cup full of toilet cleaner (corrosive acid) with a suicidal intention. Physical examination was essentially unremarkable, and the abdomen showed no signs of perforation peritonitis. X-rays of the abdomen showed multiple 'nail'-like radiopaque shadows in the abdominal cavity with no evidence of free gas under the domes of the diaphragm. A non-operative expectant management was pursued. The patient had passed all the sharps in stools without any complication and was discharged after 12 days. After 3 weeks, the patient presented with non-bilious vomiting. Further investigations revealed pyloric stenosis with no oesophageal luminal stenosis. To bypass the pyloric stenosis, a Billroth II gastrojejunostomy was performed. The postoperative period was uneventful, and the recovery was smooth.

Laparoscopic assisted foreign body extraction from the small bowel: A case report

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Only one percent of foreign body ingestion needs surgery.

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Exploratory laparotomy has been the mainstay of treatment for patients requiring surgery however surgeons are more and more tempted to use laparoscopy in emergency setting.

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The increased use of minimally invasive surgery resulted in less morbidty and faster recovery after the surgical treatment of many diseases.

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Large scale randomized controlled trials are needed before this can be used as a standard of care.

Background and aim

Foreign body ingestion is a commonly seen accident in emergencies, only 1% of them will finally need surgery. Historically, exploratory laparotomy has been the mainstay of treatment for patients requiring surgery. However surgeons are more and more tempted to use laparoscopy in emergency setting.

Through this case report we wanted to show in some selected cases the feasibility of laparoscopic assisted foreign body extraction from the small bowel leaving the patient with smaller scar, less morbidity and faster recovery.

Case presentation

A 30 year old male Inmate, ingested 40 days prior to his visit a bottom part of plastic bottle.

Physical examination found an afebrile patient with a whole abdominal tenderness but no signs of peritonitis.

The Abdominal Computed Tomography found a small bowel obstruction caused by a foreign body. No Radiological sign of perforation or peritonitis was found.

First therapeutic strategy was to wait and see, for 24 h with no sign of improvement and the patient was taken to surgery. We opted for a laparoscopic approach y. The patient had bowel and gas movement the day after surgery. In the third day, the patient had developed a parietal abscess Treated medically. In the 10th day, after surgery the patient was discharged.

Fourteenth month after the surgery, the patients is doing well with no late complication.

Conclusion

Laparoscopic assisted foreign body extraction from the small bowel is a good therapeutic option however Large scale randomized controlled trials are needed before this can be used as a standard of care.

Gastric foreign body: a comb

The ingestion of a foreign body is a common occurrence. Psychiatric patients and prisoners may swallow objects on purpose. Occasionally emergent exploratory laparotomy may be indicated if the diagnosis is uncertain, and emergent removal of the foreign body may be needed to prevent substantial risk of serious complications including perforation, fistula, or gastrointestinal bleeding.

Swallowed and aspirated dental prostheses and instruments in clinical dental practice: a report of five cases and a proposed management algorithm

BACKGROUND

Accidental swallowing or aspiration of dental instruments and prostheses is a complication of dental procedures. Failure to manage these complications appropriately can lead to significant morbidity and possibly death.

CASE DESCRIPTION

The authors present three cases of accidental swallowing of dental instruments during procedures and two cases of aspiration, one during a procedure and one long after the procedure. Although three of these five cases of foreign-body aspiration or ingestion were caught early and the patients were referred for endoscopic retrieval, two patients experienced prolonged symptoms that affected their quality of life before intervention occurred. Practical Implications The authors reviewed the literature and propose an evidence-based algorithm for management of such complications. Adherence to the proposed algorithm may decrease morbidity and mortality and improve patient outcomes.

Obstruction and perforation of the small bowel caused by inadvertent ingestion of a blister pill pack in an elderly patient

Perforation of the small bowel due to foreign body ingestion is a rare instance that occurs in less than 1% of all ingestions. Although rare, ingestion of blister pill packaging is becoming more recognised as a causative agent for intestinal perforation, but is very rarely reported to cause intestinal obstruction. This is a report of a 66-year-old woman who presented with intestinal obstruction and underwent laparotomy, revealing small bowel perforation by a piece of blister pill pack foil. The patient was incognisant of the ingestion.

Small bowel obstruction and perforation secondary to primary enterolithiasis in a patient with jejunal diverticulosis

We describe a rare case of small bowel obstruction and perforation secondary to a primary enterolith in an 84-year-old female patient with jejunal diverticulosis. She underwent an emergency laparotomy, small bowel resection and primary anastomosis. Multiple jejunal diverticula and a large stone were identified at the time of operation. Analysis of the stone demonstrated mainly faecal material consistent with a true primary enterolith. A literature search of Medline and PubMed revealed three cases similar to the one described. The pathogenesis and management of enterolithiasis in jejunal diverticular disease is considered.

What is the role of plain radiography in patients with foreign bodies in the gastrointestinal tract?

Foreign bodies (FBs) in the gastrointestinal (GI) tract can show a wide range of clinical manifestations ranging from spontaneous evacuation to severe complication. Plain radiography is a straightforward and important initial imaging modality in cases of FB ingestion or insertion and is also helpful for follow-up purposes. Careful evaluations of the plain radiographs can determine the presence and nature of FBs, and help predict their precise locations and facilitate risk assessment. In this review, a wide variety of FBs in the GI tract are illustrated, and the role of plain radiography in patient management is discussed.

A swallowed dental prosthesis causing duodenal obstruction in a patient with schizophrenia: Description of a new technique

INTRODUCTION

Foreign body ingestion has been a fundamental subject in the area of emergency surgery. The problem is encountered across all age groups; however, it is more common in the pediatric age group. Foreign body ingestion is rare in adults and usually occurs accidentally or in those with psychiatric problems, behavioral disorders, emotional disturbance, mental retardation, or impaired judgment caused by alcohol use.

PRESENTATION OF CASE

A 33-year-old Caucasian man with chronic schizophrenia was admitted to the emergency department with signs of upper gastrointestinal discomfort as a result of ingestion of a lower dental prosthesis. An abdominal X-ray showed the swallowed dental prosthesis in front of the vertebral column. A technique comprising gastrotomy and duodenal kocherization was used to remove the dental prosthesis; the prosthesis could not be removed endoscopically due to its fixed position on the duodenal wall.

DISCUSSION

Surgery of the duodenum is difficult and carries high mortality and morbidity. Therefore, endoscopy should be the first choice for patients in whom a foreign object is demonstrated to be fixed in the duodenum. In cases where endoscopic extraction fails, surgery should be considered. During surgery, foreign bodies should be removed, paying meticulous attention not to harm the integrity of the duodenum.

CONCLUSION

The technique presented in this study was performed successfully without any injury to the duodenum.

Accidental ingestion of foreign object: Systematic review, recommendations and report of a case

One of the serious complications during a routine endodontic procedure is accidental ingestion/aspiration of the endodontic instruments, which can happen when proper isolation is not done. There are at present no clear guidelines whether foreign body ingestion in the gastrointestinal tract should be managed conservatively, endoscopically or surgically. A 5 year old boy reported to the Department of Pediatric and Preventive Dentistry, D.A. Pandu Memorial R.V. Dental College, Bangalore, India, with a complaint of pain and swelling in the lower right back teeth region. Endodontic therapy was planned for the affected tooth. During the course of treatment the child accidentally swallowed a 21 mm 15 size K file. Endoscopy was performed immediately but the instrument could not be retrieved. The instrument passed out uneventfully along with the stools 48 h after ingestion. Careful evaluation of the patient immediately after the accident helps in managing the patient effectively along with following the recommended guidelines.

Accidental swallowing of orthodontic expansion appliance key

Ingestion of a foreign object, including a dental object, can lead to a trip to the emergency room. This article describes the accidental swallowing of a key that was used to activate a rapid maxillary expander. An orthodontic patient swallowed the key while trying to activate the appliance at home. The object's trajectory was followed on radiographs until it was eliminated. Possible clinical complications, legal implications of this situation, and practices for prevention are described.

Hard to swallow: a systematic review of deliberate foreign body ingestion

OBJECTIVE

Deliberate foreign body ingestion (DFBI) is often impulsively driven, repetitive and refractory to intervention and frequently necessitates multiple medical interventions. As such, the frustrations among health care providers are great, and the financial toll on health care is significant. Nevertheless, the literature on DFBI is sparse, and suggestions for treatment planning and management are limited. The authors sought to investigate and uncover efficacious treatments and strategies for preventing reoccurrence in DFBI. We build on earlier work by offering both broad and diagnosis-specific management strategies.

METHOD

A literature review was performed addressing the presentation, management and prevention of reoccurrences of DFBI. Four cases of DFBI are presented illustrating those psychiatric diagnoses (psychosis, malingering, obsessive-compulsive disorder and borderline personality disorder) most frequently encountered in hospital practice. Both broad and specific treatment approaches are presented.

RESULTS

Patients engaging in DFBI are best managed through a multidisciplinary approach, following acute medical management. Successful strategies for the prevention of reoccurrences of DFBI are inconclusive.

CONCLUSION

Understanding the function of this behavior is critical in developing treatment for patients who engage in these dangerous, potentially life-threatening, self-injurious behaviors. An amalgam of medical, pharmacological and cognitive-behavioral interventions is recommended, as is additional research.

The magnetism of surgery: small bowel obstruction in an 8-year-old boy

An 8-year-old boy with Asperger's syndrome presented with right-sided abdominal pain, which was consistent with a probable appendicitis, but revisiting the history with a high index of suspicion confirmed multiple foreign body ingestion to be the cause of his symptoms. An emergency laparotomy was performed. Multiple toy magnets and other metal objects were found, which were causing small bowel obstruction with interloop fistulation. Following removal and repair, the patient made an excellent recovery.

Endoscopic Removal of an Unusual Foreign Body Causing Gastrointestinal Bleeding

Foreign body ingestion is a condition more common in the pediatric population than in adults. In adults, although foreign body ingestion can be well tolerated, approximately 10-20% of patients require endoscopic intervention. Delayed diagnosis and unremoved foreign bodies can cause serious and fatal complications including perforation, fistula and gastrointestinal bleeding. Here we report a patient with bleeding duodenal ulcer thought to be initiated by a large foreign body.

Successful removal of indigested shell using a rigid esophagoscope and a pneumatic lithotriptor

Foreign body ingestion is a commonly encountered clinical problem in pediatric emergency cases. The authors report a case of an esophageal foreign body caused by the accidental ingestion of a shell in an 8-month-old girl. Endoscopic removal was attempted but failed because of the sharp margin of the shell and caused it to be deeply impacted into the esophageal wall. Accordingly, a pneumatic lithotriptor was inserted through a rigid esophagoscope and used to fragment the shell.

Dental root canal treatment complicated by foreign body ingestion: a case report

Introduction

Most foreign bodies pass through the gastrointestinal tract uneventfully. The majority of the reported literature describes the management of ingested blunt objects. However, ingestion of sharp objects can still occur with a higher rate of perforation corresponding to treatment dilemmas.

Case Presentation

We report the conservative management of an inadvertently ingested sharp foreign body during a routine dental procedure and describe a management strategy for the treatment of both blunt and sharp foreign bodies.

Conclusion

Urgent endoscopic assessment and retrieval is indicated when there is a history of a recently ingested sharp foreign body or if clinical suspicion suggests that the object is located within the oesophagus. Conservative management is advocated if the object has passed through the pylorus with serial clinical assessments including daily radiographs. Surgical intervention is warranted in the presence of obstruction, perforation or peritonitis.

"Metallic taste": search for the needle in a haystack (exemplary diagnostic measures and successful minimal invasive endoscopic treatment of a needle-like copper-containing foreign body in the gastric wall)

Chronic complaints and non-specific symptoms are always challenging for the selection of adequate diagnostic management and therapeutic decision making (eg, in uncharacteristic metallic taste). In this extraordinary, but exemplary case, the successful outcome for a 51-year-old woman with a chronic complaint of metallic taste (believed to be the first report in the literature as a cause of copper overload) is described. The patient underwent, after appropriate diagnostic measures, including MRI (detection), laboratory analysis of serum copper level (increased) and endoscopic ultrasound scan (localising the site), a minimal invasive treatment using endoscopic mucosectomy to remove a detected needle-like copper-containing foreign body from the intramural site of the gastric wall.